Posts Tagged ‘women’

For today’s consideration I offer up some statistics and information about two cancers common in both men and women, bladder and colorectal, along with some pointers about risk and detection.

For starters, how about a little definition of what exactly we’re talking about. First, the bladder. If you remember anything of biology or health and fitness classes, you might recall that the bladder stores urine until certain signals tell you it’s “full,” and then it contracts to help push the urine down the urethra and out of the body. Secondly, the colorectal area. Since they are connected physically and work in tandem as part of the digestive system, the colon and rectum are often grouped under the collective “colorectal” description. Essentially, the colon is the large intestine, and the rectum is the last six inches or so before the anus.

Okay, with the anatomy lesson over, lets get to the bits that actually matter. Bladder cancer is one of the more common cancers found in men and women but is rarely publicized. According to the American Cancer Society (ACS), in 2009 some 52,810 new cases of bladder cancer were expected in men. Using Census Bureau population estimates, that means any given man had a 0.00035% chance of being diagnosed with a new bladder cancer. Those are whopping odds, I know; and, ladies, you’re numbers are even lower. For 2009, any given woman had a roughly 0.00012% chance of being diagnosed with a new bladder cancer. The 18,170 estimated new cases of bladder cancer in women in 2009 means that men are several times more likely to develop bladder cancer than women are. In fact, the ACS reports that “bladder cancer incidence is nearly four times higher in men than in women and more than two times higher in white men than in African American men.” Sorry Team Blue.

But don’t let the numbers get you down. For men, the cumulative chances of developing bladder cancer remain less than 1% until age 70 and beyond. Lifetime odds are less than 4%. And the odds of dying from it? One-fifth the chance of developing it. Women, as the earlier numbers indicated, have even less to worry about: bladder cancer odds never breach 1% by age group and is only 1.2% over the course of a lifetime. So not exactly a raging pandemic by any means. Which is especially good because bladder cancer has no good method of early detection. The most effective assessment of bladder cancer involves running an endoscope up the urethra and taking a look around. For obvious reasons, this is a procedure to be avoided unless you happen to fall among a high-risk group and or show troubling signs (especially painful urination or bloody urine). For the vast majority of us, this will never be a problem, so don’t concern yourself over it too much.

Colorectal numbers are higher. The ACS expected 75,590 new cases in men and 71,380 new cases in women in 2009, making it “the third most common cancer in both men and women.” Those numbers are also fairly even between the sexes, unlike bladder cancer. However, like bladder cancer and prostate cancer and breast cancer and most other cancers as well, the highest odds come later in life. “91% of [colorectal cancer] cases are diagnosed in individuals aged 50 and older,” reads the ACS statistics release. But it also related that in both men and women, the odds of developing colorectal cancer are less than 1% until age 60. Again, little reason to worry.

But if the 5 – 5.5% chance of developing colorectal cancer over your lifetime have you on edge, there are several methods of early detection. Most of us are familiar with the colonoscopy procedures as described (and sometimes filmed) on TV, where an endoscope is run through the large intestine in search of suspicious lesions or polyps. But if that’s too invasive for your tastes, you might consider a sigmoidoscopy, where physicians examine the rectum and lower third of the colon for abnormalities through a thin device called a flexible sigmoidoscope. It takes about 15 minutes, is less invasive, and can still take biopsies of anything suspicious. It’s recommended every five years and, like conventional colonoscopy, can occasionally (but not commonly) cause bleeding or tears in the intestinal walls, both requiring surgery to repair.

If those don’t fit your fancy, perhaps a double-contrast barium enema (DCBE) would do the trick. Recommended every five to 10 years, it involves a very thorough barium sulfate enema that physicians use to examine the lower digestive tract via x-ray. It exposes the patient to less radiation than a typical CT scan (also called CAT scan) and is somewhat less invasive than colonoscopies or sigmoidoscopies. However, if you don’t mind an enema or the slightly higher radiation of CT or MRI scans, you might opt for the virtual colonoscopy. After an enema, a small tube pumps air into colon (for better differentiation) while CT or MRI scans provide images of the intestinal tract. It’s still less invasive than traditional colonoscopies but does not allow for biopsies or as thorough an internal view. However, it does allow for imaging of surrounding tissues and produces more accurate images than DCBEs.

But if you’re not fond of any foreign materials up the backside, you might just opt for the simplicity and complete non-invasiveness of fecal blood tests. There are two types but both are quite accurate and inexpensive. One type, called FOBT (fecal occult blood test), tests feces for the heme blood component (“heme” as in hemoglobin, part of our red blood cells). The other, called FIT (fecal immunochemical test), is more sensitive and tests for the globin blood component. Pre-cancerous polyps in the colon or rectum often bleed into the fecal matter passing through the digestive tract, which can be detected by these tests. They are simple enough to do at home and are sometimes handed out free of charge at proctology centers, clinics, and other medical service providers. Doctors recommend triple-testing to reduce false positives as the body expels small amounts of blood in feces under normal circumstances. But the tests return positive results for bleeding anywhere between the mouth and anus, so don’t automatically assume colorectal cancer even if there is blood. These fecal blood tests are considered a line of primary identification, as are the similar fecal DNA tests, but for conclusive diagnoses you’re still expected to see a doctor and perhaps choose a colorectal treatment of a more invasive kind.

I think the most important thing to remember is how unlikely these cancers are. And being diagnosed with cancer is a long way from dying of it. So keep an eye on yourself, and get your regular medical check-ups if you like, but don’t waste time and energy worrying about something so unlikely. No matter what you hear on the news.

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I last wrote about breast cancer in my informal “medical series” here on the blog so, to be fair, I’ll now address prostate cancer. Unlike the enthusiastic pink-banner-waving breast warriors-of-awareness, prostate cancer’s agents of information fly below the radar with little hoopla, few public endorsements, and no ribbon brigades. But statistically, prostate cancer is just as prevalent as breast cancer and results in about 30,000 deaths annually.

But how about a bit of good news to start? Most guys are familiar with the “probing finger” method of prostate examination, but how many have heard of the PSA blood test that can also be used? Ideally, the American Cancer Society suggests they be used in conjunction to help identify prostate issues, and generally only after age 50. But, fellas, there’s our loophole; you have the right to request the blood test and forego the finger.

Now, back the issue at hand (no pun intended). Prostate cancer, like many other cancers, increases in probability with age. Roughly two-thirds of cases are diagnosed in men 65 and older. And whereas a 40 year old man has only a 0.01% chance of being diagnosed with prostate cancer, a man aged 75 has a 12.5% chance. Which, incidentally, is twice the odds of a woman the same age being diagnosed with breast cancer. In fact, from age 55 on, men are at a higher probability of prostate cancer than women of the same age are of breast cancer. And over the course of a lifetime, men are over 30% more likely to develop prostate cancer than women are breast cancer. I don’t recall seeing any blue ribbons for that in the New Yorker.

And although men make up less than half of the country’s population, they are more likely to develop cancer of any major class but one. Digestive cancer? More prevalent in men. Respiratory cancer? Men. Bone, skin, brain? Men. Lymphoma, myeloma, leukemia? Still men. The only major class not led by men is cancers of the endocrine system, involving hormones. (And I dare say most men could offer an explanation for why women are number one in that.)

So I think we should begin a blue-ribbon brigade, to save the men. They are a minority in the populace, suffer a shorter average life span than women, and are at higher risk for debilitating disease. If that doesn’t deserve a ribbon, I don’t know what does. But I don’t think we can rely on super-aid-celebrities like Bono to go waving any flags for the cause (mostly because I think he needs to grow a pair first), so men, take a stand for yourselves. Wave your own banners and be your own warriors-of-awareness. And women, if you support the pink ribbon then you need to support the blue one, too. We have to fight for equal rights, equal awareness, and equal funding together, breasts and prostates alike.

Go blue!!

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This is still a fresh and highly contentious subject so please navigate away from this page after the following paragraph if it is too sensitive a subject for you. My thoughts are often … unconventional … and though I certainly mean no disrespect some things I say could be potentially hurtful to others. Please beware.

George Sodini was responsible for the deaths of three women and the injury of several others recently at a gym in Bridgeville, Pennsylvania. He left writings that outlined his plans and general attitude toward life. His last actions were terribly violent and should not be dismissed. These are my compiled notes on George Sodini and my thoughts on his life.

On paper, and even on video, George seemed like a very ordinary man. He worked an ordinary job, drove an unremarkable vehicle, and lived in a perfectly normal house. But he lived there alone and this seemingly led to (or was caused by) some of his personal issues. According to his purported “blog,” he had not been in a relationship since 1984 and had not slept with anyone since 1990. If said “blog” is genuine, it provides quite a peek into a disturbed mind.

The very first entry is studded with spite and dark sarcasm. Further entries blend melancholy, irritation, and disbelief with a perpetual foundation of frustration. “Result is I am learning [life] basics by trial and error in my 40s,” he wrote. “Seems odd, but thats true. […] Too embarassed to tell anyone this, at almost 50 one is expected to just know these things.” Later, describing his mother as a controlling, overbearing woman, he laments, “Why are people vicious with their closest ones?”

It feels almost like there are two different men writing. One is wholly negative, calling younger women “hoes” and stating that he will always be alone. But there is another man, a positive force who tries to hope that things will improve. The trouble is that the negativity always seems to win the argument. “Writing all this is helping me justify my plan and to see the futility of continuing. […] No matter how many changes I try to make, things stay the same.”

But those jumbled, sometimes resentful paragraphs help flesh George Sodini out as a real person, a living, breathing person who made a terrible, terrible choice. They portray a man who is tired of being alone but has no clue how to change. They show how out-of-control his life felt, and how he was convinced he was a total and utter failure as a human being. He seems to be saying, “Everywhere I look people have their shit together. They are getting married, are in relationships, are having kids… What is wrong with me that I am not? Why doesn’t anyone feel remotely interested in me?” None of the entries sound “crazy” or even demonstrably unstable until he mentions having “chickened out” of his plan with the guns in his gym bag. Until that point, he just sounds lonely, possibly depressed. Suddenly the post reveals him to be homicidal, suicidal, unexpectedly dangerous and seemingly without remorse for his intended victims. “God have mercy,” was his only remark.

“I already know what the problem is, but a solution eludes me,” he said months later. He attended church for many years and apparently didn’t want to go to Hell for seeing through this “exit plan” but had been assured such actions would not necessarily damn him. “[P]astor Rick Knapp … teaches (and convinced me) you can commit mass murder then still go to heaven. […] I think [he] did the most damage.” And though he did not consider the “exit plan” a real solution, it seems he could not identify a better option. Why he chose the gym one can only guess. Why his anger was funnelled into a murder spree instead of just a suicide is a mystery. But it seems odd that he would do such a thing when his words indicate that he did not hate women but their (real or imagined) rejection of him and the loneliness which followed.

His words show a man who felt lost and without hope that things would ever change. Expounding on a radio talk show caller, George wrote, “It is the quality of life that is important, he said. If you know the past 40 years were crappy, why live another 30 crappy years then die? His point was they engage in dangerous behavior which tends to shorten the lifespans, to die now and avoid the next 30 crappy years.” He had been recently promoted and liked his new boss, even found his new duties more rewarding. And yet he led a joyless life, ultimately punctuated by the shooting of innocent strangers.

I compiled all these notes and thoughts with one basic goal: to try and understand a man who felt so hopeless that he would take out his frustrations in the deaths of others and then kill himself. Many call him a blatant misogynist but I believe that falls well short. Others have labeled him “psychotic” and “psychopathic” and while I’m not sure that quite covers it, either, I think it is closer to the truth.

Psychopaths are mentally unimpaired but nonetheless engage in self-defeating acts. Often unable to delay or defer gratification, they are prone to impulsiveness, sometimes violence, and are often coupled with an inability to learn from past mistakes. Roughly one percent of the general population are psychopaths. A recent study at the Institute of Psychiatry at King’s College London found that “psychopaths who kill and rape have faulty connections between the part of the brain dealing with emotions and that which handles impulses and decision-making,” according to a Reuters article. The findings were based on a small test group and is expected to be studied further. “As well as finding clear structural deficits in the tract in psychopathic brains,” the article continues, “they also found the degree of abnormality was significantly linked to the degree of psychopathy.”

Which makes sense. The less functional the brain, the more abnormal the behavior of the host. Which opens up a whole new bag of worms. If a brain isn’t functioning properly, how responsible is the host for its actions?

George Sodini decided to take three guns into a gym and shoot people. He decided to turn the last gun on himself and end his life. These were things he chose to do and which cannot be excused. But I wonder how much of the circuitry that led him to that choice was faulty, how much it interfered with his impulses and decisions. I wonder about the other one percent of psychopaths trying to live among us while their brains unknowingly mislead them. It is such a cruel and unpredictable world when the very thing that filters the world around us and keeps us going quietly betrays us.

I am reminded of a quote from Plato:

“Be kind, for everyone you meet is fighting a hard battle.”

If you’d like to read George Sodini’s “blog” for yourself, you can find it here.

And one parting thought … why did George Sodini turn out the lights before he started shooting? Some called it cowardly, insinuating that maybe he could not face the people he killed as he killed them. We will never know for sure, but I like to think differently. He could have hit many, many more of those women if the lights had been on. I like to think it was perhaps a last act toward decency, that if he could not or would stop himself from carrying through with his plan, he could at least try to give them a better chance by firing into the dark.

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After visiting a friend’s blog, I discovered that I had completely forgotten Mother’s Day. I’m not a mother myself, and have no mother or maternal relations, so I often forget. But I think fathers are getting a raw deal.

Mother’s Day gets splashed all over the television, newspapers, and internet advertising like a second Christmas. You’re encouraged to buy jewelry, flowers, flashy cards, expensive dinner reservations, vacations, etc. But come Father’s Day, what do advertisements push? A lawnmower. A leafblower. A new golf club. What’s Dad likely to get? Some god-awful tie and a pair of socks or, if he’s lucky, a wrench set. And since Father’s Day comes about six weeks later, all the money seems to get sucked up by Mother’s Day and the Memorial Day binge that marks the beginning of summer.

What’s left for dear old Dad?

I don’t enjoy the commercialization of holidays but I do think it can be a useful indicator of our society, namely in that the level of commercialization is dependent on how important that holiday is rated. And Mother’s Day would blow Father’s Day right out of the water any day of the week. I’m not against mothers (please, how could anyone be?) but I think fathers are becoming more and more marginalized in our society. Their roles are considered expendable.

Movies, television, and commercials paint men as lust-hungry fools. And while, true, some men are lust-hungry fools, many are not. Nor are fathers’ roles quaint but expendable.

With relatively few restrictions, single mothers can draw thousands of dollars in local, state, and federal aid each year to supplement their household, in addition to receiving various other subsidies. Single fathers often can’t. Two people, of identical race, income, background, number of children, medical issues, etc., are judged unequally based on gender alone.

The man is expected to work and bring home a paycheck whether he is trying to raise children alone or not. With that check he is expected to pay the rent, or mortgage, and utility bills; keep food on the table; pay medical, dental, and optometry bills; provide suitable clothing, shoes, school supplies, etc.; pay for child care and or hire babysitters; make vehicle payments and provide for repairs, maintenance, and fuel costs; and, of course, pay his taxes.

The woman is expected to be a stay-at-home mother. In many cases, the state will help with or fully cover her mortgage or rent payments; pay part or all of her utility bills; provide hundreds of dollars in food stamps per child; provide full coverage for medical, dental, and optometry; pay for child care; provide transportation; and often supply her hundreds of dollars, per child, for other expenses. All tax-free, of course.

Though legislation surrounding it is slowly changing for the better, fathers are still often forgotten.

And on television sitcoms, it’s Dad who makes all the idiotic blunders, who is usually cast on a couch or behind a grill or clumsily fooling in a garage. Mom is Heroine Extraordinare while Dad is, at best, Bumbling Sidekick.

I’m all for Mother’s Day. I think parents are terribly overlooked and under-appreciated by their increasingly rude and selfish offspring in today’s world…

But don’t forget Dad.

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